Provider Demographics
NPI:1093945115
Name:APOLLO, LYDIA B (CNM)
Entity Type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:B
Last Name:APOLLO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2053 VALLEYGATE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3983
Mailing Address - Country:US
Mailing Address - Phone:910-484-9020
Mailing Address - Fax:910-484-9012
Practice Address - Street 1:2053 VALLEYGATE DR STE 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3983
Practice Address - Country:US
Practice Address - Phone:910-484-9020
Practice Address - Fax:910-484-9012
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13054207V00000X
NC441367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7002133Medicaid
NC7002133Medicaid